How Do Stress Fractures Occur?
Stress fractures occur due to repetitive loads on bones from exercises that cause an imbalance between bone resorption and bone repair. A sudden increase in repetitive stresses like running or cross training can unfortunately lead to increased bone breakdown and possibly even fracture. Muscle weakness can also contribute to added bone stress and eventually stress fractures.
Stress Fracture Risk Factors
Stress fractures occur more frequently in females as well as individuals with poor aerobic fitness. Naturally, individuals with poor bone density are also at increased risk for stress fractures. Other risk factors include, but are not limited to:
- Hypothyroidism and other hormone imbalances
- Excess alcohol consumption
- Amenorrhea – absence of menstruation
- Advancing age
In runners, the most common areas to be inflicted with a stress fracture are the forefoot, mid-foot and tibia. In adolescence, the proximal tibia – the portion of the shinbone that is closest to the knee – is more commonly affected. In adults, meanwhile, the middle to distal portion of the tibia – the portion of the shinbone furthest from the knee – are more frequently affected.
Stress Fracture Symptoms
Stress fractures of the lower extremities will typically cause pain over days or weeks. It might initially only cause pain when exercising. Eventually, symptoms will progress and cause pain during daily activities as well. Pain is usually relieved by rest or some less stressful cross training exercise.
The area immediately over the stress fracture may be tender to touch and is sometimes accompanied by redness or swelling. If the athlete continues to exercise, these symptoms may become more severe.
Evaluating a Stress Fracture
A stress fracture evaluation starts with a review of your medical history and physical exam by a physician. Unfortunately, X-rays of stress fractures are typically negative for the first 3-4 weeks and even then might be of little value. MRIs and bone scans, on the other hand, are often more accurate. These are the best imaging technology currently available to diagnose stress fractures, and are usually ordered when your physician has a high clinical suspicion for a stress fracture.During an evaluation, stress fractures must be differentiated from other causes of pain, such as:
During an evaluation, stress fractures must be differentiated from other causes of pain, such as:
- Medial tibial stress syndrome – shin splints
- Exercise induced compartment syndrome (a rare condition characterized by pain in the calf muscles with athletic activity)
- Infection
- Plantar fasciitis
Treating Stress Fractures
The treatment for stress fractures depends on both the location and the type of the stress fracture. All stress fractures require that you stop running on land, but most will allow you to cross train and possibly run in water. Some stress fractures do not require immobilization while others do. In general, it is necessary to limit activities to those that do not result in any pain. In some cases, this involves the use of crutches and even a cast. Some stress fractures, such as the hip (femoral neck), require surgery to prevent a complete fracture.
If you have an unusual discomfort over an area in your lower extremities that worsens with exercise, we suggest you decrease your running for two weeks and cross train on a bike or in a pool. If this rest period does not relieve your pain when you return to running, it is important that you see an experienced orthopedic physician, such as Dr. Millstein, to lessen the potential for further complications.
At Millstein Orthopedics, our goal is to to provide you with a rapid, safe, and accurate treatment plan to keep you off the couch and on the road.
If you are suffering from a stress fracture and your symptoms are not improving, schedule a consultation with Beverly Hills orthopedic surgeon Dr. Millstein by calling (310) 595-1030 today!